What Is Colitis?

No one knows for certain what causes ulcerative colitis, a chronic inflammatory condition, but you can control your symptoms with medication and lifestyle changes.

Colitis, also known as ulcerative colitis, causes inflammation and sores, called ulcers, in the inner lining of your rectum and colon. It is a form of inflammatory bowel disease (IBD). No one knows for certain what causes ulcerative colitis, but symptoms can be treated. People with ulcerative colitis can lead full, active lives.

In people with IBD, the immune system reacts to the intestinal tract as if it were a dangerous invader. You may have inherited the problem but experience symptoms only in reaction to conditions in your environment.

The usual pattern is to have flare-ups followed by periods of quiet called remission. The longer you don’t have symptoms the less likely they will return.

According to the Crohn’s and Colitis Foundation of America, about half of people with ulcerative colitis are in remission during any given year.  The other half have mild or moderate symptoms, except for about 2 percent who have severe cases.

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Risk factors for ulcerative colitis

• Age (colitis usually begins before the age of 30)
• Race (caucasians have a higher risk)
• Family history

Symptoms of ulcerative colitis

• Frequent, loose bowel movements
  
• Blood and pus in stools, called rectal bleeding
• Feeling that a bowel movement is incomplete
• Urgency (feeling that you need to have a bowel movement right away)
• Crampy, abdominal discomfort
• Rectal pain that comes and goes
• Loss of appetite
• Fatigue
• Joint pain

Ulcerative colitis treatment options

Your doctor will discuss the combination of treatments that will help you stay as active as you want to be. Keep in mind that ulcerative colitis is considered chronic. That means it usually can’t be cured. But treatment may ease symptoms.

Some patients cannot tolerate or do not respond to first-line therapies. In some cases, their symptoms return over time despite treatment. If that’s you, it’s important to speak up. You may need surgery. Also, new medications are in the pipeline that work in a novel way. You may be eligible for a clinical trial of a promising new treatment.    

Medications for colitis

Your doctor will try to find the medications that work best for you. They may include:

• A type of anti-inflammatory medication (called 5-ASA compounds or mesalamine) to help reduce intestinal swelling and inflammation
• Corticosteroids (used for short-term, not maintenance, treatment) to help reduce inflammation (swelling, short-term irritation)
• Antibiotics to fight bacteria, if there is an infection
• Medications to control your body’s immune system, such as immunomodulators or biologic agents

Lifestyle changes for colitis

• Avoid any food that makes your symptoms worse. Triggering foods vary from person to person, so you may need to keep a diary of your diet and symptoms for two weeks to identify yours. Fresh vegetables, high-fat dairy, and red meat are common triggers.
• Stress is another factor. Exercise, relaxing hobbies, music, meditation, and deep breathing can help you minimize your body’s response to stress.
• Ask your doctor whether any of your medications could increase your risk of a flare-up. Antibiotics, such as for a sinus infection, or NSAIDs (nonsteroidal anti-inflammatory drugs including aspirin, ibuprofen, and naproxen) for mild pain may be risky for you, so you’ll need to weigh the pros and cons.

If you need surgery for ulcerative colitis

After 30 years of disease, up to a third of people with ulcerative colitis will require surgery, most often a procedure called an ileal pouch anal anastomosis (or IPAA).

In the procedure, a surgeon removes the entire colon and rectum and attaches the small intestine to your anal area, creating a pouch to collect waste. The pouch allows the patient to pass stool through the anus.

Some patients who undergo this procedure develop complications, such as pouchitis (inflammation of the pouch). Some people will need a permanent ileostomy, where the fecal waste empties into an external bag attached to the patient’s abdomen.

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